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001504 (SATT)' 4.4" rtr� Building Address 79-'295 Wr3 • Circle Owner Gumal Mmogimmt . Mailing ' City Zip Contractor Address P.C. box 173 _...City ' ' Zip' P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 No.nA BUILDING: TYPE CONST.y OCC. GRP. R 3 A.P. Number 357-50Legal Description Project Descriptions PaTm .r Tel.. _' _ State Lic.City BY: MZ 1247 & Classif.� Lic. # 237. Sq. Ft= 433 Size No. No. Dw. Stories Units- Arch., Engr.,. _ Side Setback from Property Line Designer New Ek Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. AM C 323-7877t� City Zip ` _ State Palffi Satilaos 92262 Lic: #- - _ LICENSED CONTRACTOR'S DE"ARATION I hereby affirm that I am Ilcensedvn der provisions of Chapter 9 (commencing with Section - 7000) of Division 3 of the Business and Professions Code, and my license is•inyfull force and effect. -�-• • _ SIGNATURE y r f Yr ! i.+' . .P C i DATE OWNER -BUILDER DECLARATION it I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 70.3 1-5, Business and Professions Code: Any city or county . which requires a- permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant /or such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/ Division 3 of the Business and Professions Code, or that.he'is-exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant fora- permit ' subjects the applicant to a civil penalty of not more than five hundred dollars (8500). - ` . ' . ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Secs 7044, Buisness and Professions Code; The Contractor's License Law.does not apply. to.an owner of property who builds or improves thereon and who does such work himself or.through rough his own employees, provided that such improvements are not intended or offered /or sale. If, however, the building or improvement is sold within one year o/ completion, the owner -builder will have the burden o/ proving that he did not build -or improve for the purpose of sale.) + • Estimated Valuation C �f� t9�� 00 tz I ,, 7 PERMIT • ' AMOUNT - Plan Chk. Dep. - 05.72 Plan Chk. Bal. -* 202.,24 COf1St. - .7 617. 00 Mech. -'f .A 3 f .011 Electrical �iS .[ Plumbing _• ��� ❑ I, as owner of the property, am exclusively contracting.with licensed contractors to con- struct the project. (Sec. 7044, -Business and Professions, Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .. ❑ I am exempt under Sec. B. & P.C. for. this reason S. M. 1:1 Grading Driveway Enc Date Owner Infrastructure as aalreemsft WORKERS' COMPENSATION DECLARATION "I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company .❑ Copy is filed with the city.. ❑ Certified copy is hereby furnished. TOTAL 3'fF _ i�fa �t3i3 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (8100) valuation or less.) - I certify that in the performance of thg work for which this permit is issued,'I shall not • — employ any person in any manner so as t0 become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked: CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a'construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days., I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Data Mailing Address �✓ + ` / City, State, Zip f HARD COPY REMARKS ZONE: BY: Minimum Setback Distances: Front.Setback from Center. Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL.DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CARP. SO. FT. WALL SO. FT. ® SO FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ®c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL :d PERMIT APPLICATION City of La Ouinta Department of Building and Safety This permit becomes void it work not commenced within 180 days from date of Issuance. OR, if work has been suspended or abandoned for a period o1 180 days. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 -(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. Number Date Contractor OWNER -BUILDER DECLARATION: 1 hereby affirm that I am exempt from the Contractor's license Law for the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500.): O 1. as owner o1 the property, or my employees with wages as Meir sole compensation, will do the work, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's license Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvemni is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose o1 sale.). O 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's license Law.). O 1 am exempt under Sec. B.'8 P.C. (Attached Certificate). Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. Q. Policy No. 'Company O Certified copy is hereby furnished. O Certified copy is filed with the City Building Inspection Department or City Department. Date Applicant APPLICANT NAME (L. F. MI) JL Construction ADDRESS P.O. Box 173 CITY/COMMUNITY/STATE/ZIP ' Nestor; CA 92053 JOB SITE ADDREDSISPACE CITY/COM LINITY/STATE/ZIP La- to CA 92253 ROIs I PAG I PRC I C TWN RNG SE s 19903 %� 60.18 MoD lurrbmg Fee 85.00 TRACT NAME HOPJZC N PALMS OWNER NAME (l. F. MI) General Management Corp. ' CONTRACTOR -FIRM NAME J.L. Construction ADDRESS abm CITY/COMMUNITY/STATE/ZIP PHONE a 756.88 LMC . * agreentint ARC/ENG FIRM NAME Michael Buccino Assoc. ADDRESS 340 S. Farrell Dr. A212 CITY/COMMUNITY/STATE/ZIP ' Palm scIbrings. CA 92262 PHONE • LICNC / 323-7877 TOTAL FEE USE OF PERMIT single Family Dwelling BL ZON. FSB Sao SSS RSB OFC ZONE ORD • LOT SZ END SIDE the permit is for one hundred ($100) o. less. l certify that in the performance of the work for which this permit is Issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 1 hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2 Art 2. Sec341, Title 8. C.A.C.) O As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from that division. O Division of Industrial Safety Permit No. Date Applicant CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all 'city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Signature of Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify 1 have read this application and state that the information given is correct. l agree to comply with all state laws and county ordinances relating to buidling construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter upon the property for which I have applied for this permit for the purpose of making inspections. Signature of Applicant or Agent Date Print Applicant/Agent Name .6015 APPLflMMT ` DATE 2�=85 _f S.F.D. Permit to construct 1247 sq. ft. of living area and 433 sq. ft. of garage as per approved,plans. mech. Fee 37.00 Plan Check Fee 307.96 Const. Fee 367.00 60.18 SMI Fee 5.46. lurrbmg Fee 85.00 TrifrastructUre 862.60 105.72 DEP. PAID 756.88 * agreentint with Cemmini-ty t Department TOTAL FEE 862.60 H 1 L L L 7 L 6. 6 8 CK FINANCE VALUATION 77, 948.00